cardiopulm exam 1/18 (ptfe) Flashcards by Chris M

what pathology?
• Fatigue, pulmonary  edema 
• Fluid weight gain
• Dyspnea
• S3 heart sound
• Crackles in lung (fluid in lung)
• Orthopnea

L sided CHF

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what pathology?
• Fatigue, edema rest of body
• jugular distension
• Fluid weight gain
• S3 heart sound
• Orthopnea

R sided CHF

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what used to test DVT?

wells criteria

homans sign - squeeze calf

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DVT pop?

women more than men, esp. over 50 y.o.

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what pathology?
• Often asymptomatic
• Pain in the region
• Unilateral swelling, tenderness, and pain
• Warmth and discoloration
• Homan’s sign

deep vein thrombosis

• blood clots in pelvis, leg, or major UE veins

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how DVT diagnosed?

how treated?

ultrasonography

anticoagulants

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what pathology?
• Dyspnea
• Pleuritic, sharp, localized chest pain 
• Diffuse chest discomfort
• Persistent cough
• Hemoptysis
• Tachypnea, tachycardia
• Apprehension, anxiety, restlessness

pulmonary embolism

- Pulmonary vascular obstruction by displaced thrombus

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symptoms:
• Bruit heard over swollen area (listen with stethoscope)
• Abdominal/back/flank pain
• Leg pain, claudication
• Poor distal pulses
• Pulsating mass in the abdominal area (sometimes)

Abdominal Aortic Aneurysm

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what heart sound?

AV valve closure (onset of systole)

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what heart sound?
 Semilunar valve (pulmonary/aortic) closure (onset of diastole)

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what heart sound?

heard in early diastole associated with CHF, athletes (“Kentucky”)

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what heart sound?

heard in late diastole associated with MI or hypertension (“Tennessee”)

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What nerve?
primary innervator of PNS for most of viscera
what action?

Vagus CNX
• Decreases heart rate
• Decreases blood pressure

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how to stimulate CN X?

Carotid sinus massage
Valsalva maneuver
Pain

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signs of CN X lesion

dysphagia, difficulty swallowing

gag reflex, uvula deviates to strong side

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what maneuver?
Intrathoracic pressure increased against a closed glottis
what effects?

valsalva
• Collapsed veins reduce BP and HR
• Overshoot of ↑ BP and ↓HR

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when to use valsalva maneuver?

supraventricular tachycardia

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muscles contract to elevate ribs during inspiration

external intercostal

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muscle contracts to to expand thoracic cavity, flattens when contract

diaphragm

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accessory muscle for inspiration

- contracts to elevate sternum

SCM

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accessory muscle for inspiration

- contracts to pull ribs outward

pec minor

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muscle contracts to to contract pull ribs down during expiration

internal intercostals

quadratus lumborum

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muscle relaxes to reduce thoracic cavity during expiration

diaphragm

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accessory muscle for expiration

- contracts to compress abdomen

abdominals

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contralateral tracheal deviation

space occupying: Tension Pneumothorax Pleural effusion Space-occupying lesion

tracheal ipsilateral deviation

collapse: Pneumonectomy Pleural Fibrosis Atelectasis (collapse of part/all of lung)

what pathology? - life-threatening condition - air leaks into the space between the lungs and chest wall - air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function

Tension Pneumothorax

what pathology? | “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs.

Pleural effusion

right pneumonectomy - which way does trachea deviate?

right deviated trachea

what kind of breath sound? | caused by CHF, air bubbles, fluid in the alveoli

Crackles (rales)

what kind of breath sound? • Pulmonary edema, pulmonary fibrosis, infection of small bronchioles

Crackles (rales)

what kind of breath sound? | High-pitched wheezing

Wheezes

what kind of breath sound? | Asthma, partially obstructed bronchi/bronchioles

Wheezes

what kind of breath sound? | Low pitched wheezing, sonorous sleeping/snoring

Rhonchi, snoring rhino

``` what kind of breath sound? • Pneumonia, bronchitis, cystic fibrosis, COPD, secretions in larger airways ```

Rhonchi snoring rhino

what kind of breath sound? | High-pitched wheezing, upper airway blockage/object

Stridor

``` what kind of breath sound? Tracheal Stenosis (narrowing of your trachea) or object obstruction ```

Stridor

what kind of breath sound? rapid breathing followed by apnea/cardiac failure - end of life

Cheyne-stokes Respirations

Xray passes through | - air is black

radiolucent

Xray cannot pass through | - bone, metal is white

radioopaque

lung so full of fluid shows up white on Xray - air that usually fills the small airways in your lungs is replaced with something else, eg. fluid, such as pus, blood, or water

Consolidated lung

which breathing technique? • Unresisted inspiration • Exhalation through pursed lips • Prevents airway collapse, better gas exchange

pursed lip breathing

which breathing technique? • To mobilize secretions (e.g. Cystic Fibrosis) • Exhaling through open mouth (as if to steam a mirror) • “HAA” “HAA”

huffing

which breathing technique? 1. Breathing control (relaxed) 2. Deep breathing (thoracic expansion) Deep breath with 3- second hold 3. Huffing maneuver to mobilize secretions

Active Cycle Breathing

``` what pathology? • Smoking, occupational exposures, pollutants • Hypoxemia, hypercapnia • Hyperinflation “barrel chest” • Cyanosis, nail clubbing ```

COPD | Chronic airway obstruction

what pathology? • C8, T1, T2 Dermatome paresthesias (similar thoracic outlet) • horner's syndrome (Miosis, ptosis, enophthalmos) • Sharp shoulder pain, axilla, subscapular area • Pulmonary symptoms - Dyspnea, cough, hemoptysis what is it mistaken for?

Pancoast’s Tumor- Apical tumor of lung | mistaken for: thoracic outlet syndrome, OA, or impingement

what pathology? - miosis (constriction of the pupil), - ptosis (drooping of the upper eyelid), - anhidrosis (absence of sweating of the face) - Enophthalmos is the posterior displacement of the eyeball within the orbit cause?

horner's syndrome | - caused by damage to the sympathetic nerves of the face.

what patholoyg? - muscles of the forearm, wrist and hand are most affected - caused by a birth injury to the neck and shoulder due to a difficult vaginal delivery, tumor of the lung or shoulder, or trauma to the arm and shoulder. - brachial plexus nerves may be stretched or torn, causing weakness, pain or numbness.

Klumpke's palsy

what breathing pattern? | large breaths with periods of apnea

Biots

what breathing pattern? | rapid breaths with periods of apnea, near end of life

Cheyne-stokes

what breathing pattern? in response to acidosis, body tries to breathe acid (CO2) out - think boy scout blowing to start fire

Kussmaul

AHA classification for BP: | normal

<120 mmHG AND <80 mmHG

AHA classification for BP: | Elevated

120-129 mmHG AND <80mmHG

AHA classification for BP: | Stage 1 Hypertension

130-139 mmHG OR 80-89 mmHG

AHA classification for BP: | Stage 2 Hypertension

≥140 mmHG OR ≥ 90 mmHG

what term? | amount of blood in ventricle at the end of diastole (LVEDV)

Preload

what term? | force the LV must generate to overcome aortic pressure

Afterload

what term? | amount of blood ejected with each contraction

Stroke volume

what term? % of blood ejected from total volume of ventricle normal? how to calculate?

Ejection fraction • Normal 55-75% - calculate with echosonogram

what do you expect in patient with low Ejection fraction? eg. 12%

expect fatigue, dyspnea, multiple rest breaks for ADL

CV response to exercise | increased O2 demand and increased external load

* HR increases linearly * SBP increases linearly * DBP limited changes (+/- 10 mmHg) * Tidal volume and respiratory rate increase

UE or LE? | has increased sympathetic activity during exercise, greater increase in HR

UE 30-40% more than LE

UE or LE? | increase O2 demand during exercise

LE more muscle mass

UE or LE? Lower mechanical efficiency more energy cost Needs to recruit additional stabilizing postural muscles

UE (LE has more mass)

what protein further the vasoconstriction in all non-working muscles during sympathetic activity?

catecholamines

``` normal or abnormal response to exercise? • Moderate to severe, increasing angina Marked dyspnea • Dizziness, light-headedness, ataxia • Cyanosis/pallor • Excessive fatigue ```

abnormal

normal or abnormal response to exercise? | • BP response 150/120

abnormal, Hypertensive | >180/>110

normal or abnormal response to exercise? | SBP rise 10mmHg

normal

normal or abnormal response to exercise? | SBP drop 10-15mmHg

abnormal

normal or abnormal response to exercise? Significant change in EKG rhythm next steps?

abnormal wait to return to baseline If ST elevation = emergency, call 911

normal or abnormal response to exercise? | • Blunted BP response

abnormal | normal if on metoprolol, beta blocker

normal or abnormal response to exercise? | • Leg cramps, claudication

abnormal

if angina, what medication to take? how to take it? what next steps if no response?

nitroglycerin - vasodilator, a medicine that opens blood vessels to improve blood flow and angina symptoms - sublingual, under the tongue 1 tab every 5 mins, up to 3x - call 911 if unrelieved

what pathology? • chest pressure doesn’t change w position, etc • Occurs at rest without precipitating factors • Requires immediate medical intervention

unstable angina

what pathology? • ischemic chest pain • Experienced at predictable workloads/effort

stable angina

what pathology? • Vasospasm, responds to nitroglycerin treatment • Need referral for calcium channel blocker • occurs at rest

Prinzmetal angina

related to what pathology? • Decreased O2 perfusion • Tissue injury and infarction

Myocardial infarction - heart attack

related to what pathology? | • Insufficient BP to heart and vital organs

MI • Cardiogenic shock

related to what pathology? • Pt complaints- chest pain, radiate to L arm, jaw, thorax, fatigue, weakness • ECG • Cardiac enzymes (• Creatine kinase-myocardial band • Lactic dehydrogenase • Troponin • Myoglobin)

MI acute coronary syndrome

patient complaints for MI

* Intense chest pressure "elephant on my chest" * pounding headache * Radiating pain to left arm, jaw, and thorax * Compromised cardiac output, dizziness, light headed, sweating * Fatigue, weakness

female complaints for MI that can be different than men? | symptoms relieved by?

* Mental status changes (older female) * Dyspnea * Weakness, lethargy * GERD pain * Anxiety, Depression * Sensation of inhaling “cold air” * Achiness, heaviness, weakness of UE’s * Symptoms relieved by antacids

what medication used? | • hyperlipidemia with coronary artery disease

statin

``` side effects of what drug? • Myalgia, myopathy • Liver impairment (Asterixis, Carpal tunnel syndrome, Ascites, etc.) • Rhabdomyolysis • Fever • Nausea/vomiting ```

statin

``` what situation? - rapid skeletal muscle breakdown, - goes to kidney work overtime to filter out, - dark brown urine what causes? ```

rhabdomyolysis | causes - overtraining, crush injury MVA, statin electrical injury

what symptom of liver impairment? | clonus of wrist, extension cause flapping

asterixis

what pathology? symptoms mimic MI no tissue death improve with change in position- valsalva, lean forward/quadruped

pericarditis

causes of inflammation of pericardium

pericarditis • Trauma • Autoimmune, radiation • Idiopathic

``` what pathology? symptoms: • Chest pain/dyspnea • Pain aggravated by trunk movement • Fever, chills, cough • LE edema • Pain relieved by holding breath or leaning forward/ sitting upright/ kneeling on all fours ```

pericarditis

what pathology? | pericardial sac filled with fluid, crush heart

cardiac tamponade

``` what pathology? caused by • Hypertension • coronary artery disease • Dysrhythmias • Valve abnormalities • Pericardial pathology • Cardiomyopathies results: bad heart pumping action, low cardiac output, renal dysfunction because kidneys detect less fluid ```

CHF

endocrine disorder most common cause of exophthalmos.

Graves' disease

cardiopulm exam 1/18 (ptfe) Flashcards

(91 cards)